Provider Demographics
NPI:1891858106
Name:BROOKS, CAROL J (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:J
Last Name:BROOKS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3015 W. 85TH ST.
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90305-1827
Mailing Address - Country:US
Mailing Address - Phone:323-753-2521
Mailing Address - Fax:323-758-5681
Practice Address - Street 1:3015 W 85TH ST
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90305-1827
Practice Address - Country:US
Practice Address - Phone:323-753-2521
Practice Address - Fax:323-758-5681
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA340661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice